Horvath Alexandra, Zsidai Bálint, Konaporshi Shanga, Svantesson Eleonor, Hamrin Senorski Eric, Samuelsson Kristian, Zeba Nenad
Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
J Wrist Surg. 2022 Jul 11;12(2):177-190. doi: 10.1055/s-0042-1753542. eCollection 2023 Apr.
The aim of this study was to compare the rates of recurrence and wound infection in patients with primary dorsal wrist ganglion treated with aspiration (with or without an injection of an additive), open excision, or arthroscopic resection. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered on PROSPERO. Systematic electronic searches in PubMed (MEDLINE), EMBASE, Web of Science, and the Cochrane Library of Controlled Trials were performed on May 5, 2020, and June 1, 2021, respectively. All clinical studies written in English determining the recurrence and wound infection rates after treatment of primary dorsal wrist ganglion with aspiration, open excision, or arthroscopic resection in patients over the age of 16 years were eligible for inclusion. Quality assessment was guided by the Cochrane Collaboration's tool for randomized controlled trials (RCTs) and the methodological index for nonrandomized studies (MINORS) tool for observational studies. The literature searches resulted in 1,691 studies. After screening, five RCTs, enrolling 233 patients, and six observational studies, enrolling 316 patients with primary dorsal wrist ganglions were included. Quality assessment of the included RCTs and observational studies determined the existing level of evidence pertaining to primary dorsal wrist ganglion treatment to be low. About 11 studies reported on recurrence rate, which ranged between 7 and 72% for patients initially treated with aspiration (with or without an injection of an additive). In comparison, the recurrence rate for the open excision and arthroscopic resection groups ranged between 6 to 41% and 0 to 16%, respectively. Four studies investigated wound-related complications, for which zero infections were reported, irrespective of treatment. The evidence summarized in this systematic review demonstrates a considerable variability in recurrence rate following aspiration and open or arthroscopic resection of a primary dorsal wrist ganglion. The greatest variability in recurrence was displayed among studies on aspiration. The overall infection rate after treatment of dorsal wrist ganglions seems to be low regardless of the treatment type. However, the divergent results of individual studies highlight a pressing need for prospective controlled trials assessing outcomes following dorsal wrist ganglion treatment. Systematic review on level 1 to 4 clinical therapeutic studies.
本研究旨在比较采用抽吸法（有无注射添加剂）、开放性切除术或关节镜切除术治疗原发性腕背腱鞘囊肿患者的复发率和伤口感染率。
本系统评价按照系统评价与Meta分析的首选报告项目（PRISMA）指南进行，并在国际前瞻性注册系统（PROSPERO）上注册。分别于2020年5月5日和2021年6月1日在PubMed（医学文献数据库）、EMBASE、科学引文索引和Cochrane对照试验图书馆进行了系统的电子检索。所有用英文撰写的临床研究，只要确定了16岁以上患者采用抽吸法、开放性切除术或关节镜切除术治疗原发性腕背腱鞘囊肿后的复发率和伤口感染率，均符合纳入标准。质量评估以Cochrane协作网的随机对照试验工具和观察性研究的非随机研究方法学指标（MINORS）工具为指导。
文献检索共得到1691项研究。筛选后，纳入了5项随机对照试验（涉及233例患者）和6项观察性研究（涉及316例原发性腕背腱鞘囊肿患者）。对纳入的随机对照试验和观察性研究进行质量评估后确定，关于原发性腕背腱鞘囊肿治疗的现有证据水平较低。约11项研究报告了复发率，最初采用抽吸法（有无注射添加剂）治疗的患者复发率在7%至72%之间。相比之下，开放性切除术组和关节镜切除术组的复发率分别在6%至41%和0%至16%之间。4项研究调查了与伤口相关的并发症，无论采用何种治疗方法，均未报告感染病例。
本系统评价总结的证据表明，原发性腕背腱鞘囊肿采用抽吸法以及开放性或关节镜切除术治疗后的复发率存在很大差异。抽吸法相关研究的复发率差异最大。无论治疗类型如何，腕背腱鞘囊肿治疗后的总体感染率似乎较低。然而，个别研究结果的差异凸显了迫切需要进行前瞻性对照试验，以评估腕背腱鞘囊肿治疗后的结局。
1至4级临床治疗研究的系统评价
